CHANGE YOUr SMILEdisCOvEr HOw A NEw smilE CAN trANsfOrm YOUr lifE

fourth edition

Louis S. Belinfante, ddSPrivate PracticeOral and Maxillofacial SurgeryDawsonville, Georgia

farzad r. nahai, MdAssistant Clinical Professor Plastic and Reconstructive SurgeryEmory University School of MedicineAtlanta, Georgia

foad nahai, MdClinical Professor Plastic Surgery Emory University School of MedicineAtlanta, Georgia

Quintessence Publishing Co, inc

ContriButorS

ronald e. Goldstein, ddSClinical Professor of oral rehabilitation

School of dentistryMedical College of Georgia

Augusta, Georgia

Adjunct Clinical Professor of Prosthodonticshenry M. Goldman School of dental Medicine

Boston universityBoston, Massachusetts

Adjunct Professor of restorative dentistryuniversity of texas health Science Center

San Antonio, texas

Chicago, Berlin, Tokyo, London, Paris, Milan, Barcelona, Istanbul, Moscow, New Delhi, Prague, São Paulo, and Warsaw

Library of Congress Cataloguing-in-Publication Data

Goldstein, ronald E. Change your smile : discover how a new smile can transform your life / ronald E. Goldstein; contributors, louis Belinfante, farzad r. Nahai, foad Nahai. -- 4th ed. p. cm.includes bibliographical references. isBN 978-0-86715-466-5 1. dentistry--Esthetic aspects. 2. Prosthodontics. i. title. rK54.G63 2009 617.6--dc22 2009008108

illustrations by Zach turner, Blue motion studios.

Expert beauty tips on pages 200–207 and makeup for the models on pages 203, 207, and 214 by rhonda Barrymore, professional makeup artist and stylist and founder and president of Help me rhonda, inc.

Hairstyles for the models on pages 203, 207, and 214 by richard davis, professional hairstylist.

virtual hairstyle images and expert advice on pages 209–213 provided by theHairstyler.com.

©2009 Quintessence Publishing Co, inc

Quintessence Publishing Co inc4350 Chandler driveHanover Park, il 60133www.quintpub.com

All rights reserved. this book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without prior written permission of the publisher.

Editor: Kathryn funk design: Gina ruffoloProduction: Gina ruffolo and Angelina sanchez

Printed in China

dediCAtion

This book is dedicated to the memory of a dentist who was the ultimate dental-patient consumer advocate. In addition to being a perfectionist and committed to excellence, he was a protector of patients’ best interests.

His love of dentistry and his concern for people fueled his passion for helping others. His life and example served to inspire all who knew him. He helped me. He inspired me.

This book is dedicated, then, in loving memory to my father, Dr Irving H. Goldstein.

tABlE Of CONtENtsACKNOWLEDGMENTS viii

PrEfACE ix

fACiNG iT 1 discover what makes a smile beautiful, then perform a self-analysis to decide if you’re ready for a change.

STAiN, STAiN, GO AWAy 27 find out how you can get rid of stains and discolorations to achieve a bright, vibrant new smile.

COMiNG CLEAN 45 Learn how eliminating decay and old silver fillings can help you obtain a spotless smile.

CrACKiNG DOWN 57 don’t let a fractured tooth stand in the way of your sexy smile—discover restorative options that will look and feel like the real thing, or better!

MiND ThE GAP 69 find out what a difference filling the spaces between your teeth can make in your overall appearance.

LOST AND fOuND 85 rediscover your full smile by replacing missing teeth with natural-looking restorations.

STrAiGhTEN uP AND SMiLE riGhT 103 there’s no reason to go through life with a crooked or crowded smile—learn how you can get your teeth in order and have the straight smile you’ve always wanted.

1

2

3

4

5

6

9

8

10

1112

7

fiNDiNG CLOSurE 119 Your bite can dramatically affect both your appearance and your ability to function normally— discover what kind of bite you have and steps you can take to improve it.

iT’S AbOuT TiME 141 is your smile making you look older than you feel? Learn why it’s never too late to have a youthful smile.

GuMMiNG uP ThE WOrKS 159 don’t let problems with your gums ruin the overall appearance of your smile! find out what you can do to get your smile back in the pink.

AbOuT fACE 171 discover what orthognathic and plastic surgery can do for your smile and overall facial esthetics.

fiNiShiNG TOuChES 195 Learn from the experts what you can do to maintain your gorgeous new smile and enhance your entire facial appearance with proper skin care, makeup application, and hairstyling techniques.

APPENDix: hOW iT’S DONE 216 Wondering how a veneer is placed or how invisible braces work? See the steps and procedures involved in many of the solutions presented throughout the book.

ChANGE A SMiLE, ChANGE A LifE 232 See how you can help underprivileged high school students achieve the smile of their dreams.

rEfErENCES 234

tABlE Of CONtENtsACKNOWLEDGMENTS viii

PrEfACE ix

fACiNG iT 1 discover what makes a smile beautiful, then perform a self-analysis to decide if you’re ready for a change.

STAiN, STAiN, GO AWAy 27 find out how you can get rid of stains and discolorations to achieve a bright, vibrant new smile.

COMiNG CLEAN 45 Learn how eliminating decay and old silver fillings can help you obtain a spotless smile.

CrACKiNG DOWN 57 don’t let a fractured tooth stand in the way of your sexy smile—discover restorative options that will look and feel like the real thing, or better!

MiND ThE GAP 69 find out what a difference filling the spaces between your teeth can make in your overall appearance.

LOST AND fOuND 85 rediscover your full smile by replacing missing teeth with natural-looking restorations.

STrAiGhTEN uP AND SMiLE riGhT 103 there’s no reason to go through life with a crooked or crowded smile—learn how you can get your teeth in order and have the straight smile you’ve always wanted.

1

2

3

4

5

6

9

8

10

1112

7

fiNDiNG CLOSurE 119 Your bite can dramatically affect both your appearance and your ability to function normally— discover what kind of bite you have and steps you can take to improve it.

iT’S AbOuT TiME 141 is your smile making you look older than you feel? Learn why it’s never too late to have a youthful smile.

GuMMiNG uP ThE WOrKS 159 don’t let problems with your gums ruin the overall appearance of your smile! find out what you can do to get your smile back in the pink.

AbOuT fACE 171 discover what orthognathic and plastic surgery can do for your smile and overall facial esthetics.

fiNiShiNG TOuChES 195 Learn from the experts what you can do to maintain your gorgeous new smile and enhance your entire facial appearance with proper skin care, makeup application, and hairstyling techniques.

APPENDix: hOW iT’S DONE 216 Wondering how a veneer is placed or how invisible braces work? See the steps and procedures involved in many of the solutions presented throughout the book.

ChANGE A SMiLE, ChANGE A LifE 232 See how you can help underprivileged high school students achieve the smile of their dreams.

rEfErENCES 234

viii

so much is new in this 25th-anniversary edition of Change Your Smile. the world has changed dramatically since i wrote the first edition in 1984, and so has esthetic dentistry. the treatment options for attaining the smile of your dreams are much more widely available. New materials and techniques make improving your smile less invasive and much more pleasant while providing even better results. Advancements in technology allow you not only to virtually see how great your new smile can look before any treatment begins but also to better predict how long it will last once it is completed. technologic innovations have also enabled much more efficient communication, which means you often will have more choices based on input from your general dentist and various specialists working on your behalf—your dentist can even have an instant consultation with a specialist during your treatment!

Nevertheless, over the more than 50 years i’ve been practicing cosmetic dentistry, i’ve seen one thing remain the same—more attractive smiles dramatically improve patients’ self-image. they feel better and smile more. Change Your Smile is designed to assure you that you don’t have to go through life with a smile you don’t like. You can feel better about your smile and yourself—regardless of your age, your budget, or the extent of your problem.

the critical first step is completing the smile analysis in chapter 1, which will help you determine exactly what you don’t like about your smile. do you have an underbite or overbite? Unhealthy gums? fractured teeth? signs of aging? You may find that the problem in your smile isn’t what you thought it was or that it’s not really your smile at all that needs changing. it’s essential to determine this before you begin treatment, because if you address the wrong problem, you’ll never be happy with the solution.

the pages that follow are filled with examples of the characteristics you might like to change in your smile. these are accompanied by the range of possible solutions. You’ll learn, in a streamlined format, the benefits and potential limitations of various treatments, their costs, and how long you can expect the results to last. Not sure what a porcelain veneer is or how a crown is placed? the appendix contains simple illustrations and descriptions of all the techniques described in the book, so you’ll

know exactly what is involved in any treatment you’re considering. i cannot overemphasize the importance of learning as much as possible about treatment alternatives before you visit your dentist. informed patients have a much better chance of obtaining the results they’re looking for.

Use this book first to educate yourself about what you want and how you can get it, then as a tool to communicate with your dentist. take the time to have an open conversation with your dentist and make sure your needs and expectations are fully understood and that you completely understand the treatment that is planned for you. Over the years, i’ve had too many patients ask me to redo their smiles because they were unhappy with the results they received elsewhere. there was no malpractice in most of these cases; instead, a lack of proper communication between the patient and the dentist led to esthetic failure.

if this describes your current situation—that is, if you’ve already had changes made to your smile but are still dissatisfied with your appearance—have an honest discussion with your dentist. He or she will be able to tell you if there’s anything else that can be done for your smile and help you discover whether there’s something else in your appearance that is actually causing your dissatisfaction. Chapter 11 presents procedures for major facial changes that can help improve your appearance and correct problems that a smile makeover cannot. if the problem is a defect that simply can’t be fixed, try following the tips in chapter 12 to improve your health and beauty routines. simple changes in your skin care, makeup, and hairstyling techniques may balance out or camouflage the problem. this is also a great chapter for those who have changed their smile but want to take the next step in improving their overall look. You won’t believe the difference a few small adjustments can make in your appearance, confidence, and outlook on life.

i began writing Change Your Smile believing that the better educated we are about what it takes to achieve our goals and meet our needs, the more expertly we’ll exercise the right to get the results we want. After you read this book, you’ll know what to discuss with your dentist before you’ve invested your time and hard-earned money. my hope is that reading this book will give you the tools you need to better communicate with your dentist to do just that. After all, it’s your smile!

PrefACeACknoWLedGMentS A great many people have helped to make Change Your Smile possible. most of them were acknowledged in the three previous editions, but certain individuals deserve recognition for making the fourth edition possible.

first and foremost, i feel fortunate to have two great clinicians in my partners and friends, david Garber and maurice salama, who helped me in so many ways, including reviewing many areas of the manuscript. i am very grateful to have had the help and good counsel of my mentor, Charles Pincus, of blessed memory, whom i miss dearly.

i owe a great deal of appreciation to my dentist sons, Cary and Ken, and my dentist daughter, Cathy schwartz, who provide me with instant advice and make me very proud, as does my physician son, rick, who also helps keep me in good health. i also want to thank my extended family—my associates who have been so helpful whenever i have called upon them, especially Henry salama, Angie Gribble Hedlund, Brian Beaudreau, maha El-sayed, and Noell Craig.

so many people helped me create the esthetic results in this book that it would take too long to enumerate them. Nevertheless, this edition was aided by the talent and valuable technical skills of ceramists Pinhas Adar, Christian Coachman, Guilherme Cabral, Chris delarm, dental technician tony Hood, and our long-standing metalworks technician, mark Hamilton.

this new edition was vastly improved by the splendid editorial and visual talent of Katie funk. thanks also go to my editorial assistant, Yhaira Arizaleta Grigsby, who handled the bulk of details necessary to bring this book to fruition. she was a tough taskmaster, but that is certainly what it takes to complete a project such as this.

A great deal of thanks goes to my entire office staff and especially to the talented dental assistants who have helped me over the years. i am indebted to our office manager Gail Cummins, accountant Chuck Gugliotta, current dental assistants laura mcdonald and Angelica tafur, past dental assistants maria Hernandez and Angie moon, and particularly the unusual dedication and many other talents of Charlene Bennett. i have been privileged for more than 20 years to use the administrative abilities of Candace Paetzhold, who is the best editor and proofreader of all my writings. Our hygiene team has been of much help to me as well as to the patients. i would particularly like to thank Kim Nimmons, Gail Heyman, and the other

hygienists, including Amy Bahry, Akiko Hartman, Janet Kaufman, and Cheri robinette, who maintain the esthetic treatment of most of the patients in this book.

some of the folks at dentalXP have aided me as well, especially Chris mcGarty, Amber vaughn, livio Yoshinaga, and James romeo.

Communication has always been at the core of what Change Your Smile is about, so i thank our treatment coordinators, lisa Bursi, drue tovi, and Joy williams, who have gone to great lengths to interpret this book’s philosophy for patients. i must thank our “main man,” victor Ekworomadu, who keeps our entire office staff on track. He is the ideal employee and a real credit to mankind.

i also want to thank talented photographers sundra Paul and Alberto Oviedo, who were helpful to me for this edition, and especially dudu medeiros, one of Brazil’s premier photographers.

i would like to thank my terrific medical College of Georgia team, especially van Haywood, who has always been so gracious in sharing his material, and dean Connie drisko, a great faculty leader and my friend. Over the years i have gained so much knowledge and assistance from so many colleagues that i could not possibly name them all, but they know who they are, and i am eternally grateful for their dedication to the profession.

i really appreciate the contributions by louis Belinfante and foad and farzad Nahai, who so beautifully show that there should be no limitation in getting the total facial look you desire. i also owe thanks to rhonda Barrymore, richard davis, and the experts at theHairstyler.com, who helped me demonstrate how makeup and hairstyles can enhance anyone’s smile.

i am indebted to many others for their suggestions and especially to my family for their support and for putting up with my work habits: Amy, Jody, and Jill Goldstein; Katie, Jennie, and steve schwartz; and my wife, Judy, whose support, judgment, and insight continue to make this a better book.

most of all, i never could have produced this book without the cooperation of my wonderful patients from the past 50 years (and still counting) and their willingness to share their smiles.

ix

viii

so much is new in this 25th-anniversary edition of Change Your Smile. the world has changed dramatically since i wrote the first edition in 1984, and so has esthetic dentistry. the treatment options for attaining the smile of your dreams are much more widely available. New materials and techniques make improving your smile less invasive and much more pleasant while providing even better results. Advancements in technology allow you not only to virtually see how great your new smile can look before any treatment begins but also to better predict how long it will last once it is completed. technologic innovations have also enabled much more efficient communication, which means you often will have more choices based on input from your general dentist and various specialists working on your behalf—your dentist can even have an instant consultation with a specialist during your treatment!

Nevertheless, over the more than 50 years i’ve been practicing cosmetic dentistry, i’ve seen one thing remain the same—more attractive smiles dramatically improve patients’ self-image. they feel better and smile more. Change Your Smile is designed to assure you that you don’t have to go through life with a smile you don’t like. You can feel better about your smile and yourself—regardless of your age, your budget, or the extent of your problem.

the critical first step is completing the smile analysis in chapter 1, which will help you determine exactly what you don’t like about your smile. do you have an underbite or overbite? Unhealthy gums? fractured teeth? signs of aging? You may find that the problem in your smile isn’t what you thought it was or that it’s not really your smile at all that needs changing. it’s essential to determine this before you begin treatment, because if you address the wrong problem, you’ll never be happy with the solution.

the pages that follow are filled with examples of the characteristics you might like to change in your smile. these are accompanied by the range of possible solutions. You’ll learn, in a streamlined format, the benefits and potential limitations of various treatments, their costs, and how long you can expect the results to last. Not sure what a porcelain veneer is or how a crown is placed? the appendix contains simple illustrations and descriptions of all the techniques described in the book, so you’ll

know exactly what is involved in any treatment you’re considering. i cannot overemphasize the importance of learning as much as possible about treatment alternatives before you visit your dentist. informed patients have a much better chance of obtaining the results they’re looking for.

Use this book first to educate yourself about what you want and how you can get it, then as a tool to communicate with your dentist. take the time to have an open conversation with your dentist and make sure your needs and expectations are fully understood and that you completely understand the treatment that is planned for you. Over the years, i’ve had too many patients ask me to redo their smiles because they were unhappy with the results they received elsewhere. there was no malpractice in most of these cases; instead, a lack of proper communication between the patient and the dentist led to esthetic failure.

if this describes your current situation—that is, if you’ve already had changes made to your smile but are still dissatisfied with your appearance—have an honest discussion with your dentist. He or she will be able to tell you if there’s anything else that can be done for your smile and help you discover whether there’s something else in your appearance that is actually causing your dissatisfaction. Chapter 11 presents procedures for major facial changes that can help improve your appearance and correct problems that a smile makeover cannot. if the problem is a defect that simply can’t be fixed, try following the tips in chapter 12 to improve your health and beauty routines. simple changes in your skin care, makeup, and hairstyling techniques may balance out or camouflage the problem. this is also a great chapter for those who have changed their smile but want to take the next step in improving their overall look. You won’t believe the difference a few small adjustments can make in your appearance, confidence, and outlook on life.

i began writing Change Your Smile believing that the better educated we are about what it takes to achieve our goals and meet our needs, the more expertly we’ll exercise the right to get the results we want. After you read this book, you’ll know what to discuss with your dentist before you’ve invested your time and hard-earned money. my hope is that reading this book will give you the tools you need to better communicate with your dentist to do just that. After all, it’s your smile!

PrefACeACknoWLedGMentS A great many people have helped to make Change Your Smile possible. most of them were acknowledged in the three previous editions, but certain individuals deserve recognition for making the fourth edition possible.

first and foremost, i feel fortunate to have two great clinicians in my partners and friends, david Garber and maurice salama, who helped me in so many ways, including reviewing many areas of the manuscript. i am very grateful to have had the help and good counsel of my mentor, Charles Pincus, of blessed memory, whom i miss dearly.

i owe a great deal of appreciation to my dentist sons, Cary and Ken, and my dentist daughter, Cathy schwartz, who provide me with instant advice and make me very proud, as does my physician son, rick, who also helps keep me in good health. i also want to thank my extended family—my associates who have been so helpful whenever i have called upon them, especially Henry salama, Angie Gribble Hedlund, Brian Beaudreau, maha El-sayed, and Noell Craig.

so many people helped me create the esthetic results in this book that it would take too long to enumerate them. Nevertheless, this edition was aided by the talent and valuable technical skills of ceramists Pinhas Adar, Christian Coachman, Guilherme Cabral, Chris delarm, dental technician tony Hood, and our long-standing metalworks technician, mark Hamilton.

this new edition was vastly improved by the splendid editorial and visual talent of Katie funk. thanks also go to my editorial assistant, Yhaira Arizaleta Grigsby, who handled the bulk of details necessary to bring this book to fruition. she was a tough taskmaster, but that is certainly what it takes to complete a project such as this.

A great deal of thanks goes to my entire office staff and especially to the talented dental assistants who have helped me over the years. i am indebted to our office manager Gail Cummins, accountant Chuck Gugliotta, current dental assistants laura mcdonald and Angelica tafur, past dental assistants maria Hernandez and Angie moon, and particularly the unusual dedication and many other talents of Charlene Bennett. i have been privileged for more than 20 years to use the administrative abilities of Candace Paetzhold, who is the best editor and proofreader of all my writings. Our hygiene team has been of much help to me as well as to the patients. i would particularly like to thank Kim Nimmons, Gail Heyman, and the other

hygienists, including Amy Bahry, Akiko Hartman, Janet Kaufman, and Cheri robinette, who maintain the esthetic treatment of most of the patients in this book.

some of the folks at dentalXP have aided me as well, especially Chris mcGarty, Amber vaughn, livio Yoshinaga, and James romeo.

Communication has always been at the core of what Change Your Smile is about, so i thank our treatment coordinators, lisa Bursi, drue tovi, and Joy williams, who have gone to great lengths to interpret this book’s philosophy for patients. i must thank our “main man,” victor Ekworomadu, who keeps our entire office staff on track. He is the ideal employee and a real credit to mankind.

i also want to thank talented photographers sundra Paul and Alberto Oviedo, who were helpful to me for this edition, and especially dudu medeiros, one of Brazil’s premier photographers.

i would like to thank my terrific medical College of Georgia team, especially van Haywood, who has always been so gracious in sharing his material, and dean Connie drisko, a great faculty leader and my friend. Over the years i have gained so much knowledge and assistance from so many colleagues that i could not possibly name them all, but they know who they are, and i am eternally grateful for their dedication to the profession.

i really appreciate the contributions by louis Belinfante and foad and farzad Nahai, who so beautifully show that there should be no limitation in getting the total facial look you desire. i also owe thanks to rhonda Barrymore, richard davis, and the experts at theHairstyler.com, who helped me demonstrate how makeup and hairstyles can enhance anyone’s smile.

i am indebted to many others for their suggestions and especially to my family for their support and for putting up with my work habits: Amy, Jody, and Jill Goldstein; Katie, Jennie, and steve schwartz; and my wife, Judy, whose support, judgment, and insight continue to make this a better book.

most of all, i never could have produced this book without the cooperation of my wonderful patients from the past 50 years (and still counting) and their willingness to share their smiles.

ix

Facing ItYour smile plays a major role in how you perceive yourself, as well as in the impressions you make on the people around you. Surveys have shown that more than any other physical feature—eyes, hair, or body—the smile is what both men and women find most attractive in other people. A charming smile can open doors and knock down barriers that stand between you and a fuller, richer life. If, on the other hand, you are dissatisfied with your smile, it may be holding you back from fully embracing life and its opportunities.

Are you ready for a new smile? Perhaps you’ve wondered whether straighter teeth might help you feel more confident in your professional life, or if a whiter, brighter smile might boost a dwindling social life.

If you’re not completely happy with your smile, perhaps it’s time to get a new one!

It all begins with

your smile!

1FIND OUT . . .

Why A new SmIle mAY be the chAnge You need

hoW to evAluAte Your SmIle

KEyS to gettIng the beSt coSmetIc dentAl

treAtment

Facing ItYour smile plays a major role in how you perceive yourself, as well as in the impressions you make on the people around you. Surveys have shown that more than any other physical feature—eyes, hair, or body—the smile is what both men and women find most attractive in other people. A charming smile can open doors and knock down barriers that stand between you and a fuller, richer life. If, on the other hand, you are dissatisfied with your smile, it may be holding you back from fully embracing life and its opportunities.

Are you ready for a new smile? Perhaps you’ve wondered whether straighter teeth might help you feel more confident in your professional life, or if a whiter, brighter smile might boost a dwindling social life.

If you’re not completely happy with your smile, perhaps it’s time to get a new one!

It all begins with

your smile!

1FIND OUT . . .

Why A new SmIle mAY be the chAnge You need

hoW to evAluAte Your SmIle

KEyS to gettIng the beSt coSmetIc dentAl

treAtment

tipexpert Stop staining

your teeth!

• Limit the amount of coffee and tea in your daily diet.

• Avoid smoking.• Make regular visits to your dentist

for professional cleanings.• Brush and floss regularly and

properly. Some toothpastes have compounds that can help remove minor stains for a whitening effect.

28

2

why Do teeth stain? There are a number of reasons that teeth stain. Foods, beverages, and medications may discolor teeth. Smoking or forgetting to brush and floss on a regular basis may also lead to staining. In other cases, discoloration may be the result of genetics or disease. 101

smi le What stains teeth?

Stained teeth can be caused by drinking cola, coffee, and tea; consuming other stain-producing foods such as betel nuts, blueberries, or red wine; or using tobacco. These stains are called surface stains.

BE

FO

RE

AF

TE

R

Cut back on coffee to reduce stains » Even with frequent cleanings, stains due to drinking large amounts of coffee may rapidly return. This man’s smile was greatly improved by a professional cleaning, replacement of the filling in the left central incisor, and a reduction in the amount of coffee he drank.

Plaque can stain teeth » Plaque can build up on teeth and cause stains, referred to as soft deposits. This is usually the result of inadequate oral hygiene (brushing and flossing).

What you should knoW

sURFaCe stainst Occur primarily between teeth and on the surfaces of crooked teeth

t Typically are dark brown

t Are caused by strong discoloring agents such as coffee, tea, and tobacco

t Usually can be managed with daily oral hygiene combined with regular visits to your dentist for professional cleanings

t May be trapped in microcracks and require a more aggressive treatment than professional cleanings alone (although bleaching can cause the microcracks to become even whiter than or a different color than the rest of the tooth)

soFt DePositst Are caused by plaque—a sticky film that builds up on the teeth over time—or tartar (calculus)—

a cement-like substance that forms when plaque is not removed

t Often are bacterial in origin

t May be the by-product of ineffective oral hygiene

t Can appear as dark or whitish areas around the gum line, most often on the lower front teeth

t Typically disappear after thorough dental scaling and polishing

Don’t chew ice!Microcracks caused by chewing ice or other hard objects can trap stains and are difficult—or more often impossible—to clean.

tipexpert

29

tipexpert Stop staining

your teeth!

• Limit the amount of coffee and tea in your daily diet.

• Avoid smoking.• Make regular visits to your dentist

for professional cleanings.• Brush and floss regularly and

properly. Some toothpastes have compounds that can help remove minor stains for a whitening effect.

28

2

why Do teeth stain? There are a number of reasons that teeth stain. Foods, beverages, and medications may discolor teeth. Smoking or forgetting to brush and floss on a regular basis may also lead to staining. In other cases, discoloration may be the result of genetics or disease. 101

smi le What stains teeth?

Stained teeth can be caused by drinking cola, coffee, and tea; consuming other stain-producing foods such as betel nuts, blueberries, or red wine; or using tobacco. These stains are called surface stains.

BE

FO

RE

AF

TE

R

Cut back on coffee to reduce stains » Even with frequent cleanings, stains due to drinking large amounts of coffee may rapidly return. This man’s smile was greatly improved by a professional cleaning, replacement of the filling in the left central incisor, and a reduction in the amount of coffee he drank.

Plaque can stain teeth » Plaque can build up on teeth and cause stains, referred to as soft deposits. This is usually the result of inadequate oral hygiene (brushing and flossing).

What you should knoW

sURFaCe stainst Occur primarily between teeth and on the surfaces of crooked teeth

t Typically are dark brown

t Are caused by strong discoloring agents such as coffee, tea, and tobacco

t Usually can be managed with daily oral hygiene combined with regular visits to your dentist for professional cleanings

t May be trapped in microcracks and require a more aggressive treatment than professional cleanings alone (although bleaching can cause the microcracks to become even whiter than or a different color than the rest of the tooth)

soFt DePositst Are caused by plaque—a sticky film that builds up on the teeth over time—or tartar (calculus)—

a cement-like substance that forms when plaque is not removed

t Often are bacterial in origin

t May be the by-product of ineffective oral hygiene

t Can appear as dark or whitish areas around the gum line, most often on the lower front teeth

t Typically disappear after thorough dental scaling and polishing

Don’t chew ice!Microcracks caused by chewing ice or other hard objects can trap stains and are difficult—or more often impossible—to clean.

tipexpert

29

Which Solution iS BeSt for You?

100

6

FIXED BRIDGE REMOVABLE BRIDGE COMPLETE DENTURE IMPLANTS

TREATMENT TIME 2–4 weeks

MAINTENANCEClean daily under the bridge with floss threaders.

RESULTS Esthetic tooth replacement

TREATMENT LONGEVITy*

Conventional and cantilever: 5–15 years Resin-bonded: 5–10 years

COST†

• Conventional and cantilever: $950 to $3,500 per tooth

• Resin-bonded: $650 to $2,500 per tooth

ADVANTAGES• Feels more like natural teeth• Can be most esthetic• Helps prevent movement of adjacent and

opposing teeth• Improves the bite• Resin-bonded: Avoids reduction of

adjacent teeth

DISADVANTAGES• If one of the attached teeth fails, the

entire bridge fails. • May be difficult to repair if porcelain chips

or fractures.• Requires an anesthetic.

2–4 office visits

• Conventional: Remove and clean after eating.

• Precision-attachment: Clean and adjust regularly.

• Conventional: Least expensive way to replace missing teeth

• Precision-attachment: More esthetic than a conventional removable bridge

5–10 years

• Conventional: $850 to $3,500 per tooth, depending on the design and material used

• Precision-attachment: $950 to $5,000 per tooth

• Economical method of tooth replacement

• Easy to repair

• Can cause wear and trauma to attached teeth

• May not be as esthetic as a fixed bridge • Precision-attachment: Attachments

can break or wear

2–5 office visits

Clean after meals to remove and prevent stains on denture.

Esthetically pleasing results are possible

5–10 years; tooth fracture may occur (but is easy to repair), and relining may be necessary during this time

$525 to $5,000 per denture (expect to pay up to 2×–3× this amount for special “cosmetic” dentures)

• Excellent esthetics possible• More youthful appearance obtainable• Supports lips and cheeks• Can improve speech

• Less chewing efficiency.• Retention may be a problem.• Needs maintenance.• May need to be replaced every

5–10 years.• May impede speech in some instances.

• Surgical placement: about 1 hour per implant

• Healing: about 3 mo in lower jaw and 6 mo in upper jaw

• Second surgery (if needed): 30–60 min • Immediate loading: 2 hours or more

per implant

• Floss and perform home care daily.• Have a restorative exam every 3–4 mo.

• Natural appearance possible• Good individual functioning

Indefinite, barring infection. Life expectancy of the restoration is the same as described elsewhere (for a crown, 5–15 years)

$985 to $2,800 per implant (plus additional cost of crowns)

• Most closely approximate having your own natural teeth

• Avoid reduction of adjacent teeth• Can be flossed like natural teeth• Help preserve bone• Have approximately 95% success rate over 40-year life span of implant

• 3%–7% failure rate.• Ceramic implants can fracture.• Abutment screws can loosen or break. • Requires an anesthetic.

* This estimate is based on the author’s clinical experience combined with three university research studies and insurance company estimates. Your own experience could be different, depending on many factors, only some of which you and your dentist can control.

† Fees will vary from dentist to dentist based on the difficulty of the procedure, patient problems, patient dental and medical history, expectations, and dentist qualifications, including technical and artistic expertise.

‡ Expect to pay extra for esthetic temporaries.

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Which Solution iS BeSt for You?

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6

FIXED BRIDGE REMOVABLE BRIDGE COMPLETE DENTURE IMPLANTS

TREATMENT TIME 2–4 weeks

MAINTENANCEClean daily under the bridge with floss threaders.

RESULTS Esthetic tooth replacement

TREATMENT LONGEVITy*

Conventional and cantilever: 5–15 years Resin-bonded: 5–10 years

COST†

• Conventional and cantilever: $950 to $3,500 per tooth

• Resin-bonded: $650 to $2,500 per tooth

ADVANTAGES• Feels more like natural teeth• Can be most esthetic• Helps prevent movement of adjacent and

opposing teeth• Improves the bite• Resin-bonded: Avoids reduction of

adjacent teeth

DISADVANTAGES• If one of the attached teeth fails, the

entire bridge fails. • May be difficult to repair if porcelain chips

or fractures.• Requires an anesthetic.

2–4 office visits

• Conventional: Remove and clean after eating.

• Precision-attachment: Clean and adjust regularly.

• Conventional: Least expensive way to replace missing teeth

• Precision-attachment: More esthetic than a conventional removable bridge

5–10 years

• Conventional: $850 to $3,500 per tooth, depending on the design and material used

• Precision-attachment: $950 to $5,000 per tooth

• Economical method of tooth replacement

• Easy to repair

• Can cause wear and trauma to attached teeth

• May not be as esthetic as a fixed bridge • Precision-attachment: Attachments

can break or wear

2–5 office visits

Clean after meals to remove and prevent stains on denture.

Esthetically pleasing results are possible

5–10 years; tooth fracture may occur (but is easy to repair), and relining may be necessary during this time

$525 to $5,000 per denture (expect to pay up to 2×–3× this amount for special “cosmetic” dentures)

• Excellent esthetics possible• More youthful appearance obtainable• Supports lips and cheeks• Can improve speech

• Less chewing efficiency.• Retention may be a problem.• Needs maintenance.• May need to be replaced every

5–10 years.• May impede speech in some instances.

• Surgical placement: about 1 hour per implant

• Healing: about 3 mo in lower jaw and 6 mo in upper jaw

• Second surgery (if needed): 30–60 min • Immediate loading: 2 hours or more

per implant

• Floss and perform home care daily.• Have a restorative exam every 3–4 mo.

• Natural appearance possible• Good individual functioning

Indefinite, barring infection. Life expectancy of the restoration is the same as described elsewhere (for a crown, 5–15 years)

$985 to $2,800 per implant (plus additional cost of crowns)

• Most closely approximate having your own natural teeth

• Avoid reduction of adjacent teeth• Can be flossed like natural teeth• Help preserve bone• Have approximately 95% success rate over 40-year life span of implant

• 3%–7% failure rate.• Ceramic implants can fracture.• Abutment screws can loosen or break. • Requires an anesthetic.

* This estimate is based on the author’s clinical experience combined with three university research studies and insurance company estimates. Your own experience could be different, depending on many factors, only some of which you and your dentist can control.

† Fees will vary from dentist to dentist based on the difficulty of the procedure, patient problems, patient dental and medical history, expectations, and dentist qualifications, including technical and artistic expertise.

‡ Expect to pay extra for esthetic temporaries.

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